- 作者：Christopher B. Overgaard ; Vladim¨ªr D?av¨ªk ; Christopher E. Buller ; Li Liu ; Waldemar Banasiak ; Gerard Devlin ; Aldo P. Maggioni ; Jonathan Leor ; Jeffery R. Burton ; Gilmar Reis ; Witold Ruzyllo ; S ; ra A. Forman ; Gervasio A. Lamas ; Judith S. Hochman ; for the OAT Investigators
- 关键词：Diabetes ; Open artery hypothesis ; Percutaneous coronary intervention ; Occluded artery
- 刊名：International Journal of Cardiology
- 出版年：2013
- 出版时间：3 October, 2013
- 年：2013
- 卷：168
- 期：3
- 页码：2416-2422
- 全文大小：460 K
Background
Percutaneous coronary intervention (PCI) of a persistently totally occluded infarct-related artery (IRA) in stable high-risk patients > 24 h after myocardial infarction (MI) does not reduce the occurrence of death, re-infarction, or heart failure. Diabetic patients are at higher risk for cardiovascular events; we examined their outcomes overall with PCI and optimal medical therapy alone (MED).Methods
The long-term (7-year) outcomes of 454 diabetic patients (20.6 % ) randomized to PCI or MED in the Occluded Artery Trial (OAT) were assessed for the composite primary endpoint of death, re-MI, or New York Heart Association class IV heart failure. Diabetics and non-diabetics were compared and outcomes assessed by treatment strategy.
Results
The 7-year cumulative primary event rate for diabetic patients was 35.0 % vs. 19.4 % in the non-diabetic cohort (p < 0.001). Multivariable analyses revealed diabetes to be an independent predictor (p < 0.01) for the primary outcome, fatal or nonfatal recurrent MI, Class IV Heart Failure (HF), and death. The 7-year cumulative primary event rates were 35.3 % in the PCI group vs. 34.5 % in the medical therapy group in diabetic patients (p = 0.19) and 19.3 % in the PCI group vs. 19.5 % in the medical therapy group in patients without diabetes (p = 0.60).
Conclusions
Despite the higher overall risk conferred by the presence of diabetes, PCI did not improve clinical outcomes in this subpopulation, and is not indicated in otherwise stable patients with a totally occluded infarct-related artery in the sub-acute phase after MI.